The Medicare Physician Fee Schedule (MPFS) is a comprehensive list of payment rates that Medicare uses to reimburse physicians, nurse practitioners, therapists, and other healthcare providers for covered services. CMS updates the fee schedule annually. The MPFS lookup tool is publicly available and lets you search payment rates by procedure code, provider type, or geographic area.
How to Access the MPFS Lookup Tool
The official tool is available on the CMS website at cms.gov/medicare/physician-fee-schedule/search. You can search by:
HCPCS/CPT procedure code (e.g., 99213 for an office visit)
Keyword (e.g., "office visit" or "MRI")
Geographic location (national rates or locality-adjusted rates)
Year (current or prior years)
What the Results Show
| Field | What It Means |
|---|---|
Non-facility price | Medicare's payment rate when the service is performed in a doctor's office |
Facility price | Medicare's payment rate when the service is performed in a hospital or outpatient facility |
Participating amount | Amount paid to providers who accept Medicare assignment |
Non-participating amount | Amount paid to providers who do not accept assignment (5% less) |
Limiting charge | Maximum a non-participating provider can charge you (115% of the non-participating rate) |
Your Cost Is 20% of the Medicare-Approved Amount
After you meet your Part B deductible ($257 in 2026), Medicare pays 80% of the approved amount and you pay 20%. The MPFS shows the total approved amount, so multiply by 0.20 to estimate your share. A Medigap plan can cover all or part of that 20%.
Medicare Assignment and Why It Matters
A provider who "accepts Medicare assignment" agrees to accept the Medicare-approved amount as full payment and cannot bill you more than the standard 20% coinsurance. A provider who does not accept assignment can charge up to 15% above the Medicare rate (the "limiting charge"), meaning your out-of-pocket cost could be higher. You can verify whether a specific provider accepts assignment using the Care Compare tool at medicare.gov.
Practical Uses for Beneficiaries
The MPFS lookup tool is most useful when you want to estimate your cost for a planned procedure, verify that a provider's charges are within Medicare's approved range, or understand why a claim was paid at a certain amount. It is also helpful when comparing the cost of having a procedure done in a doctor's office versus a hospital outpatient facility, since facility rates are often significantly lower.
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